title: Neurologic outcomes at school age in very preterm infants born with severe or mild growth restriction.
abstract: OBJECTIVE
  To determine whether mild and severe growth restriction at birth among preterm infants is associated with neonatal mortality and cerebral palsy and cognitive performance at 5 years of age and school performance at 8 years of age.
  
  
  METHODS
  All 2846 live births between 24 and 32 weeks' gestation from 9 regions in France in 1997 were included in a prospective observational study (the EPIPAGE [Étude Epidémiologique sur les Petits Ages Gestationnels] study) and followed until 8 years of age. Infants were classified as "small-for-gestational-age" (SGA) if their birth weight for gestational age was at the <10th centile, "mildly-small-for-gestational-age" (M-SGA) if birth weight was at the ≥ 10th centile and <20th centile, and "appropriate-for-gestational-age" (AGA) if birth weight was at the ≥ 20th centile.
  
  
  RESULTS
  Among the children born between 24 and 28 weeks' gestation, the mortality rate increased from 30% in the AGA group to 42% in the M-SGA group and to 62% in the SGA group (P < .01). Birth weight was not significantly associated with any cognitive, behavioral, or motor outcomes at the age of 5 or any school performance outcomes at 8 years. For the children born between 29 and 32 weeks' gestation, SGA children had a higher risk for mortality (adjusted odds ratio [aOR]: 2.79 [95% confidence interval (CI): 1.50-5.20]), minor cognitive difficulties (aOR: 1.73 [95% CI: 1.12-2.69]), inattention-hyperactivity symptoms (aOR: 1.78 [95% CI: 1.10-2.89]), and school difficulties (aOR: 1.74 [1.07-2.82]) compared with AGA children. Being born M-SGA was associated with an increased risk for minor cognitive difficulties (aOR: 1.87 [95% CI: 1.24-2.82]) and behavioral difficulties (aOR: 1.66 [95% CI: 1.04-2.62]).
  
  
  CONCLUSIONS
  In preterm children, growth restriction was associated with mortality, cognitive and behavioral outcomes, as well as school difficulties.
authors.affiliation: INSERM, UMR 953, Epidemiological Research in Perinatal Health and Women's and Children Health, Bâtiment de recherche, Hôpital Tenon, Paris, France. isaguellec@hotmail.com
authors.forename: Isabelle
authors.initials: I
authors.lastname: Guellec
authors.forename: Alexandre
authors.initials: A
authors.lastname: Lapillonne
authors.forename: Sylvain
authors.initials: S
authors.lastname: Renolleau
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Charlaluk
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Roze
authors.forename: Stéphane
authors.initials: S
authors.lastname: Marret
authors.forename: Rachel
authors.initials: R
authors.lastname: Vieux
authors.forename: Kaminski
authors.initials: K
authors.lastname: Monique
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Ancel
mesh_terms: D001925:Brain Damage, Chronic / Q000175:diagnosis* / Q000401:mortality; D002648:Child; D002653:Child Behavior Disorders / Q000175:diagnosis / Q000401:mortality; D002675:Child, Preschool; D003072:Cognition Disorders / Q000175:diagnosis / Q000401:mortality; D005260:Female; D005317:Fetal Growth Retardation / Q000175:diagnosis*; D005865:Gestational Age; D006801:Humans; D007223:Infant; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D007235:Infant, Premature, Diseases / Q000175:diagnosis* / Q000401:mortality; D007236:Infant, Small for Gestational Age; D019102:Infant, Very Low Birth Weight; D007859:Learning Disabilities / Q000175:diagnosis / Q000401:mortality; D008297:Male; D009460:Neurologic Examination; D009468:Neuromuscular Diseases / Q000175:diagnosis / Q000401:mortality; D012307:Risk Factors; D015996:Survival Rate